Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM where we instantly improve the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, have PEACE OF MIND, real power, real control and so that you can influence decision making fast, even if you’re not a doctor or a nurse in Intensive Care!
This is another episode of “YOUR QUESTIONS ANSWERED“ and in last week’s episode I answered another question in this series of questions from my client Veronica and the question last week was PART 3 of
You can check out last week’s episode by clicking on the link here.
In this week’s episode of “YOUR QUESTIONS ANSWERED“, I want to answer the next question from one of my clients Veronica, which are excerpts from phone and email counselling and consulting sessions with me and the question this week is
My Dad (71) is in ICU with stage 4 lung cancer & stroke, he’s on the ventilator now and in an induced coma, what are his chances of survival? (PART 4)
Veronica continues with her Dad’s situation below as follows
9am I saw dad prior to the meeting and got his levels from the nurse and all the reports I needed. Dad was sedated still at the time and not responsive.
His levels this am were
Oxygen from the ventilator 45%
Arterial Blood pH- 7.38
Oxygen saturation 96.3
He is getting 2 of Noradrenalin/Norepinephrine
I asked about his kidneys and they said fine and no concern at the moment.
His ventilator is set to volume 400 mls in SIMV mode and he is breathing also by himself but was not in rhythm with the ventilator.
9.40am Dad’s Oncologist met with mum and I this am and he showed us dad’s scans from his I-pad so we could see what is happening in the lungs and it looks like they are honeycombed, and stiff. He discussed the steroid treatment they started yesterday. And the possible cause of dads lung fibrosis he believes is a side effect of the trial immunotherapy drug dad had been on that is known to cause lung fibrosis over time, he also believes it might be able to be reversed with the steroids over a long period, but time will tell.
He advised us that he does not have as much control in the hospital and influence on dad’s treatment as the head consultant Dr xxxxxxxxx of the ICU and that if dad was in the public hospital he would have been dead by now. He told us he is really pushing to keep dad on treatment as he also believes it is the right thing to do as he thinks there is a possibility of reversing the pulmonary fibrosis as he thinks it has only shown up recently.
At 10am after the meeting with Dr xxxxxxx mum and I went back in to spend more time with dad and the nurse advised us that she turned the ventilation into Pressure support ventilation(PSV)/ CPAP as dad was not breathing in rhythm with it and he did not need it as he is breathing on his own and she reduced the level so he is now just getting assistance from it. She also said it will be better for dad to have less sedation and reduced his Propofol from 30 to 15.
She said he would start to wake up and it would be better for him in the long run as long as he is not resisting anything.
Dad started to respond to us very quickly and could answer by nodding to questions and move his arms. We left at 10.30am.
I called the hospital again after lunch to see how dad was and his same nurse said no change since we left and that dad is not in pain and he understands what is happening and is not resisting his treatment. She advised me she would not be increasing the sedation overnight as long as he is not distressed.
I have not heard from the hospital tonight.
I will call them again in the am like normal to get his levels.
I am visiting dad after work tomorrow at 3.30pm hoping nothing has changed and everything is improving.
The challenge for me at the moment is that the professor of the ICU has to write up the steroids for dad and today he did not and I had to chase it up to make sure dad got them which he did get them once I advised them. He is going to be a problem this Professor xxxxxxx and I will now have to check daily to make sure dad is going to be given his steroids.
PS the Professor/head consultant Dr xxxxxxxx in the ICU is keeping away from us at present.
I’m glad to hear that Dr xxxxxxxx is keeping the ICU consultant on his toes.
On the other hand I’m shocked to hear that you have to chase up the steroids for your Dad, that’s very much public hospital mentality the ICU consultant is bringing to the table! If anything, I call this negligence on the ICU consultant’s behalf and I feel like he needs to be called out on it. It’s disgraceful!
If you’re back in there tomorrow and that’s still an issue you may actually bring this to the Nurse in charge/ Unit Manager attention. You may also report this to the Hospital CEO/ Director of Nursing as in the private system in particular, they will be responsive to your complaint.
Especially if the ICU consultant is trying to avoid you because you need to chase up steroids, you need to escalate this to hospital management.
If anything, I do actually think that Hospital management would want to know about this sort of stuff happening in ICU because they often lack this insight and I do believe they will take this rather serious.
You having to chase up treatment in ICU for your Dad that has been agreed upon is just highly inappropriate!
Dr xxxxxxx will be getting away with that sort of thing in the public system but not in the private system if you’re reporting this to a CEO/Director of Nursing level.
Your Dad’s blood gas is looking OK, PCO2 has gone up slightly. 45 -50 is usually the highest limit that can be tolerated.
You mention your Dad is getting around 400 mls per breaths and if his breathing was dys-synchronous I’m not surprised that his PCO2 is up compared to yesterday.
It is suggested that Patients should breathe 7-10 mls/kg per breath, therefore I assume your Dad is more than 40 kg, he should be getting more than 400 mls/breath, that would probably get his PCO2 back in the 35 range.
It’s very positive to note that they changed the ventilation mode from SIMV to Pressure support ventilation mode(PSV/CPAP).
It means your Dad is awake enough to breathe with minimal support, therefore he’s coming closer to getting off the ventilator.
For example, now they should be able to switch off the Propofol and they should be able to get your Dad more awake.
This may not happen straight away and it can be a process of a few days when coming out of an induced coma.
- The 5 Mistakes you are unconsciously making if your critically ill loved one is in an induced coma and is not “waking up”!
On the positive side, PO2 84 is a good reading.
I’m glad to hear they are weaning Propofol and I’m glad to hear that your Dad is following everything that’s happening, that’s very encouraging.
2 of Noradrenaline should come off once your Dad is off the Propofol. One of the main side effects of Propofol is low blood pressure, hence the Noradrenaline/Norepinephrine which is an inotrope/vasopressor counteracting low blood pressure.
Good to hear that the kidneys are working and that’s a sign that his blood pressure wasn’t too low, because sustained low blood pressure can cause acute kidney failure.
The question forward will really be if your Dad can come off the ventilator and the breathing tube? They will need to continue the arterial blood gases as well as chest x-rays in order to get an indication if they can take the breathing tube out(=extubation)
Also, have a look if they wean your Dad off the ventilator according to these guidelines here
Anything you need please let me know.
We’ll talk tomorrow.
How can you become the best advocate for your critically ill loved one, make informed decisions, get peace of mind, control, power and influence quickly, whilst your loved one is critically ill in Intensive Care?
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- How to ask the doctors and the nurses the right questions
- Discover the many competing interests in Intensive Care and how your critically ill loved one’s treatment may depend on those competing interests
- How to eliminate fear, frustration, stress, struggle and vulnerability even if your loved one is dying
- 5 mind blowing tips& strategies helping you to get on the right path to making informed decisions, get PEACE OF MIND, control, power and influence in your situation
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- How to stop being intimidated by the Intensive Care team and how you will be seen as equals
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- How you need to manage doctors and nurses in Intensive Care (it’s not what you think)
Thank you for tuning into this week’s YOUR QUESTIONS ANSWERED episode and I’ll see you again in another update next week!
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This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!
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